ORIF Fixation

ORIF FIXATION

Bone injuries, fractures become very serious, critical and painful at times. The orthopedic treatment to such severe injuries might also involve surgical procedures. Depending upon the location of injury, type of bone and age of person etc. the surgical procedure is carried out. This surgical procedure related to the treatment of severe fractures is also termed as ORIF fixation (Open Reduction Internal Fixation).

Mewar Hospital, the chain of orthopedic hospitals, is one of the recognized specialty hospitals in the state having experienced team of orthopedic practitioners and surgeons. They have successfully treated many critical cases that had undergone ORIF fixation.

The ORIF involves a surgical step by step procedure to fix the severe bone injuries and fractures. Here the term “Open Reduction” refers to realignment of bone fracture to a normal posture. Whereas the “Internal Fixation” refers to the fixation of steel rods, plates and screws. This keeps the bone fracture affixed and helps in healing in a right manner. The surgical repairing of hip joints, knee replacement etc. is also termed as ORIF at several times.

The ORIF surgery is performed by the specialist in orthopedics. The orthopedics is a branch medical science that deals with the muscular and skeletal system of human body. The procedure of ORIF involves by making an opening at the location of fracture under the influence of local anesthesia. After installing the hardware the incision is closed with stitches and the same could be replaced after the injury has healed. In some cases the hardware installation is made permanent.

There are several risks and complications involved in open reduction internal fixation procedure which may include bacterial colonization of the bone, infection, stiffness and loss of range of motion, non-union, mal-union, damage to the muscles, nerve damage and palsy, arthritis, tendonitis, chronic pain associated with plates, screws, and pins, compartment syndrome, deformity, audible popping and snapping, and possible future surgeries to remove the hardware.

The complications of ORIF could involve infection, swelling and the problem in proper movement of the installed hardware. Since the growth of bones is a very slow process hence the recovery may take several months. The period of recovery at times also depends upon the degree of severity, location of the fracture, type of bone and the age of the patient.

The recovery in the cases of bone fracture undergone with open reduction internal fixation is quite painful and doctors mostly concentrate on proper pain management of the patient. Several researches have shown or proven that use of ibuprofen and other non steroid anti inflammatory drugs (NSAID) slow down the rate of healing. Thus it makes it very essential that only the prescribed drugs should be given to the patient for the effective pain relief and proper healing.

Once the surgery followed by the medication is exercised and the patient is relieved to an extent, the next phase carried out the rehabilitation process is physiotherapy. Giving physical therapy is an important aspect of recovery and rehabilitation.

The part of the body that undergoes the surgery is held immobilized for several months that might weakens the muscles, ligaments and tendons. To rehabilitate the muscles the physiotherapy assists in restoring the strength, movement of the injured area. This is also very helpful in pain removal. This therapy involves exercises, nerve stimulation, hot and cold packs and several other combinations.

Source: http://www.mewarhospitals.com/orif-fixation/

Arthroscopy

ARTHROSCOPY

(Image Source: Londonkneeclinic)

Arthroscopy is a minimal surgical procedure performed on a joint using arthroscope by making a small incision. In a case of an injury that damages the tissues of joints requires a minimal surgical process for the treatment. Sports injuries mostly clubbed into this category. It is done to treat or to evaluate many orthopedic situations including torn surface, cartilage, trimming of damaged cartilage and reconstruction. The cartilage is also termed as meniscus by many orthopedic professionals.

The surgical instruments used in case of arthroscopy are usually smaller than the normal surgical equipments. Surgeons diagnose the joint area, tissues and ligaments using a video monitor.

The main advantage of arthroscopy over the traditional open surgery is that these joints are not required to open fully. For the knee arthroscopy two small incisions are made one for each arthroscope and surgical instruments. Arthroscopy reduces the recovery time and enhances the success rate. This is very useful for the professional sportsmen who often injure their knee joints and stipulate faster healing.

The smaller incisions make it less scary. It is possible to undergo arthroscopy for almost every joint but it is commonly used for knee, shoulder, elbow, wrist, ankle, foot, and hip. The process of arthroscopy involves the use of irrigation fluid to distant the joint for making space for surgery. In some cases the fluid penetrates into the surrounding soft tissues causing edema.

Mewar Hospital is the biggest chain of orthopedic hospitals in Rajasthan and Madhya Pradesh serving the humanity through the pristine profession of medical & health care. Our experienced team orthopedic surgeons have successfully carried many arthroscopic procedures. The arthroscopy procedure could be performed in the following given situations:

1. Arthroscopic Partial Meniscectomy (APM): The primary aim to perform APM is to trim or repair the torn or damaged meniscus that is the reason this surgery is termed as Arthroscopic Partial Meniscectomy. The APM is not that very effective for adults suffering from mild osteoarthritis. In many cases a damaged meniscus does not show symptoms.

2. Osteoarthritis: Arthroscopic surgeries of the knee are done for many reasons. Still it is not clear whether it is more effective for osteoarthritis apart from the traditional conservative therapies. However this is still a widely adopted treatment for a range of conditions including Labral Tears, Femoroacetabular impingement and Osteochondritis Dissecans. A study made in year 2008 confirmed that there was no long term benefit for chronic pain, above medication and physical therapy.

3. Knee: The modern knee arthroscopy has replaced the traditional arthrotomical surgery. Now day’s arthroscopy of knee is executed for treatment of injured meniscus, reconstruction of anterior ligament and cartilage micro fracture. Arthroscopy can also be performed just for diagnosing and checking of the knee; however, the latter use has been mainly replaced by magnetic resonance imaging.

4. Hip: Earlier the arthroscopy of hip was performed for the diagnosis of hip pain. Now it is widely used in different condition of hip inside and outside the hip joint. There are varied conditions for which hip arthroscopy used. These include the following: labral tears, loose / foreign body removal, hip washout or biopsy, cartilage lesions, osteochondritis dissecans, ligamentum teres injuries and reconstruction) Iliopsoas tendinopathy, trochanteric pain syndrome, snapping iliotibial band, osteoarthritis, sciatic nerve compression, ischiofemoral impingement and direct assessment of hip replacement.

5. Wrist: Arthroscopy of the wrist is used to investigate and treat symptoms of repetitive strain injury, fractures of the wrist and torn or damaged ligaments. It can also be used to ascertain joint damage caused by wrist osteoarthritis.

6. Spine: In many invasive spinal procedures it involves the removal of the bone muscles and ligaments in order to access the problem area. In certain mid-spine cases the surgeon requires to access the problem area through the rib cage. This might elongate the recovery time for the patient. Arthroscopic procedure allows access to and treatment of spinal conditions with minimal damage to surrounding tissues. Recovery time is significantly reduced due to the relatively small size of incisions. Recovery rate may vary according to the severity and overall health of the patient.

7. Shoulder: All the shoulder related procedures were performed by opening the joint through big incisions before the introduction of arthroscopy. Arthroscopic shoulder surgeries have gained momentum in the past decade. The keyhole surgery of the shoulder as it is popularly known has reduced inpatient time and rehabilitation requirements and is often termed as a daycare procedure. Arthroscopy of shoulder is commonly used for treatment of diseases including the following:

Subacromial impingement, acromioclavicular osteoarthritis, rotator cuff tears, frozen shoulder, chronic tendonitis, removal of loose bodies and partial tears of the long biceps tendon and shoulder instability.

The most common indications include subacromial decompression, bankarts lesion repair and rotator cuff repair.

Source: http://www.mewarhospitals.com/arthroscopy/

CRIF – (Closed Reduction Internal Fixation) FIXATION

CRIF – (Closed Reduction Internal Fixation) FIXATION

(Image Source: Physiorehab)

With the rapid rise in longevity the femoral neck fractures are also increasing at an exponential rate. The femoral neck fracture is also termed as hip fracture. It occurs near the point of origin or the proximal end of the femur near the hip. The femur is the largest bone in the human body and it is vulnerable and prone severe fracture. Most of the times the femur neck fracture occurs due to osteoporosis, a medical condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D. It is one of the most common consequences of injuries in the elderly people. With the advancement in surgical techniques and medical & health care the method of femoral fixation and the associated risks factors such as non union and Avascular Necrosis (AVN) has not much changed in past fifty years.

Emergency internal fixation is one of the main options for the treatment of displaced femoral neck fractures.  The process contains both Open Reduction Internal Fixation (ORIF) and Closed Reduction Internal Fixation (CRIF).

What is CRIF

Closed Reduction Internal Fixation (CRIF) is reduction without any open surgery which is followed by internal fixation. It is also termed as Clamp and Rod Internal Fixation system which is a modular implant system composed of clamps, rods and screws. The rod could be cut according to the length required and contoured in the plain surface of the bone. The screws fix the rod to the bone with the help of the clamps. Together the complete structure offers greater flexibility to the orthopedic surgeons. There are variety of implants such as rods, clamps and screws that are used depending upon the shape and size of the bone to be treated.

Mewar Hospital is the biggest chain of orthopedic hospitals in Rajasthan and Madhya Pradesh serving the humanity through the pristine profession of medical & health care. Our experienced team orthopedic surgeons have successfully carried many ORIF and CRIF fixation.

CRIF has an advantage that it avoids the injury to the medial circumflex femoral artery. However, the pressure formed by CRIF due to prolonged extension on the fracture table reduces the blood supply to the femoral head. The repeated forceful manipulation increases the risk of Avascular Necrosis (AVN).

It is found after many different analyses that the risk can chances of AVN of femoral head are quite significant and higher after CRIF as compared to ORIF. However, there are no significant differences in the healing rate for the two kinds of reduction processes. ORIF has advantages as compared with CRIF in terms of AVN for the treatment of femoral neck fractures.

The Key Features of CRIF

There are various key benefits and features associated with CRIF procedure and implants etc. They could be clubbed as follows:

Size: They are available in three sizes as mini, small and medium which can be used according to the requirement or the bone size.

Screws: It uses the standard cortical and cancellous screws.

Techniques: It can be used with open or minimally invasive techniques.

Rod Size: Rod sizes are versatile and can be cut to length according to the requirements.

Rod Fitting: The rods can be contoured in multiple planes for automatic optimal fitting. This offers optimum support to the bones.

Clamps: Clamps can be positioned anywhere on the rod and they can be rotated to any side of the rod to allow maximum screw placement.

Inventory: The entire clamp system is versatile that requires much less inventory.

CRIF Procedure

The usual procedure of a CRIF involves the following set of procedures:

1. Choice of fixation method: According to the type of fracture the choice of internal fixation is made as the method of treatment. Depending upon the stability required the surgeon could choose a sliding hip screw type of implant.

2. Positioning of the patient: The patient is positioned supine on the fracture table. The uninjured led is placed on a leg holder. The reduction is checked in both AP and lateral view.

3. Technique of insertion: The next step requires positioning the guide wire on the neck and hammering into the head. This would help in insertion of the guide wire for the DHS screw.

4. Insertion of the guide wire: In the further step the guide wire is inserted through an aiming device into the subchondral bone of the head.

5. Determination of the length of the DHS screw: The length of the DHS screw is determined with the help of a measuring device.

6. Drilling: After adjusting the triple reamer the hole is drilled of chosen length for the screw and the plate sleeve.

7. Screw insertion: The appropriate screw is mounted on the handle and inserted over the guide wire. By turning around the handle it gets advanced into the bone. It is not recommended to push forcefully as it may distract the fracture. After the screw has reached the required place the plate is placed in position.

8. Fixation of the DHS plate: In the last step the DHS plate is affixed with the screws. In case of femur the plate with femur is fixed with one or more screws. For additional stability cannulated screw above DHS is also inserted.

Source: http://www.mewarhospitals.com/crif-fixation/

Bone Grafting

In certain bone ailments such as severe fracture or damage to the bone only fixation of implants are not sufficient. Bone Grafting is one of the surgical treatment that is applied in such cases to carry on the artificial bone development. Mewar Hospital specializes in the surgical procedure of Bone Grafting. Our expert team of orthopedic surgeons at Mewar Hospital, the largest chain of orthopedic hospitals, can carry out the procedure if required for the seriously injured patients.

What is Bone Grafting?

Bone Grafting involves a surgical procedure to fix the ailments related to bones and joints. It involves transplanting bone tissue for fixing bones, joints etc. around the implant devices or in cases of total knee replacement. The bone used for grafting can be taken from the patient’s body or from some donor. After the acceptance of the graft the new bone tissues start forming. The two types of bone graft methods are:

Allograft – Here the bone is taken from the deceased donor or a dead patient.

Autograft – Here the graft is made from a bone inside a patient’s body, such as the ribs or hips. The type of graft used depends on the type of injury or the surgeon treating the patient.

When Bone Grafting is Applied?

Bone grafting is done for various reasons and these are as follows:

Fractures: For multiple or complex fractures bone graft is applied that cannot be healed using normal treatment.

Fusion: This process helps in healing two bones together across a diseased joint.

Regeneration: It is used for bone that is lost due to disease, infection or injury. This involves using small amount in bone cavities or large section of bones.

Implanted Devices: Bone graft can be helpful in healing where implants devices have been implied surgically.

The Risks Involved in Bone Grafting

The surgical process of bone grafting involves certain minor risks. These could be:

• Pain
• Nerve Injury
• Rejection of the Bone Graft
• Inflammation

Preparing for the Bone Grafting : 

Before performing the surgery, the doctor will perform a complete medical history and physical examination to ensure that it is safe to perform the bone grafting. In most cases the patients are required to fast prior to the surgery to prevent any kind of complications. Our surgeons will give the complete instructions about the pre procedures to be incorporated before surgery.

Bone Grafting Procedure :

Our surgeons will decide the type of bone graft to be performed. Shortly before the operation a general anesthesia will be given to the patient. The anesthesiologist will be monitor the patient continuously and his recovery. Our surgeon will make the incision where graft is required to be made. Using varied devices the graft will be held in place. After that the incision will be closed with stitches and bandages.

Precautions After Bone Grafting : 

Typical recovery of the bone grafting depends on the size of the graft and other variables. Usually it takes from two weeks to three months. Vigorous exercise affecting the muscles of graft area must be avoided. To prevent pain and inflammation after the surgery icing can help. The muscles group not affected by the surgery should be exercised to keep the body in good shape. A healthy diet will also help in catalyzing fast recovery. Research show that smoking causes failures in recovering the bone graft hence it should be avoided.

Source: http://www.mewarhospitals.com/bone-grafting/